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NEW-TYPE OXYGEN CYLINDERS: A WARNING
524 The Minister should read them side by side, not just to pick out paragraphs which suit the current trends of his administrative machine, but in order so to plan, in cooperation with the Minister of Education, that as our 80% of obsolete hospitals are rebuilt and resited over the course of the next generation, the provision for sick children comes slowly to accord, as closely as the density of population of any given area will allow, with the ideals set forth in these two reports. No overall plan in which areas of different population density are similarly treated will do. Each area will have its own problems and its own solutions. The two reports do, however, point inevitably to the provision, in those few areas where population density is high enough, of large children’s hospitals catering for acute cases from the immediately surrounding area, and for long-stay cases from further afield. It is in such hospitals that the highest standards of medical and nursing treatment, of welfare, and of education can be provided. And it is upon these few hospitals that the children’s services of the country as a whole must rely for the development of ideal standards, for the further advance in knowledge of children’s diseases, and for the output of those specialised children’s nurses whose provision in sufficient numbers is so essential for the proper nursing of sick children whether in children’s hospitals or in the children’s wards of adult
Reticence or even repulsion from applying one’s mouth that of an apnoeic, but otherwise relatively well, patient should never be a consideration when a human life is involved. to
Department of Anæsthesia, Anaesthesia, University of Saskatchewan, Saskatoon, Canada.
B DOBKIN. ALLEN B. DOBKIN
THE FŒTAL ELECTROCARDIOGRAM AS A MEANS OF MINIMISING IRRIDIATION OF THE FŒTUS IN UTERO SIR In view of recent appreciation of radiation hazards, the tendency is to decrease irradiation of the foetus
possible. X-ray examination in suspected multiple pregnancy has been a fairly routine procedure, and a similar technique is used to gain informa-
in
utero to as
tion about the
little
as
position
of the foetus in difficult cases,
as
hospitals. Queen Mary’s is, in fact, now in a new " heyday " as a general children’s hospital, and if Sir Harry Platt would pay us the honour of a visit, as I hope he will, I think he would agree that the interests of the children in this area would best be served, and his committee’s recommendations most fully implemented, if the children’s hospital services of this area were concentrated upon Queen Mary’s. Queen Mary’s Hospital for Children, Carshalton, Surrey.
Fig. 1—Fœtal electrocardiogram in 3 normal vertex presentations. The fcetal complexes are directed up and the maternal complexes are
DAVID LAWSON.
NEW-TYPE OXYGEN CYLINDERS: A WARNING
SIR,—Iwas amazed at a remark in Dr. H. M. Bird’s letter of Jan. 31, 1959: " Fortunately the patient was not on controlled respiration, or he might well have died." It seems to me that every qualified physician, and particularly one who administers anxsthetics, should be able to apply effective artificial respiration to an apnoeic patient without the aid of a gas machine whenever the need arises!
directed down. The fcetal heart-rate is faster than the mater.
nal.
well as for other reasons, including diagnosis of foetal life. The foetal electrocardiogram with recently improved technique may prove to be an adequate alternative method, especially for diagnosis of multiple pregnancy, and particularly because it presents no radiation hazard. Methods and instrumentation have been described.1-3
Fig. 1 shows 3 examples of normal foetal electrocardiograms, with the foetus in vertex presentation. The foetal heart-rate is
"
For Breath Too is Nutrient " (Meneely 1) should never be the apnoeic victim has been dragged from the water, struck down in the street, partially buried in a cavein, or rendered apnoeic by the administration of curare. Of all the physicians who should be able to support the life of an apnoeic patient, the anxsthetist should be the last to be dependent entirely on a gas machine in order to prevent a patient from dying because controlled respiration is used and the machine suddenly becomes useless for administration of oxygen. Blowing air intermittently through an oral airway, or directly into the mouth of the victim while pinching the nose and supporting the mandible, should always be performed promptly until efficient mechanical devices can be applied, or until the victim has restarted spontaneous adequate breathing. If mouth-to-airway or mouth-to-mouth artificial respiration is kept in mind always, no anaesthetised patient’s life would ever be jeopardised just because an oxygen tank became empty and a proper replacement was not available, or did not fit the machine.
forgotten, whether
1.
Meneely, G.
R. Amer.
J. Med. 1955, 19, 323
Fig. 2—Fœtal electrocardiogram are
presenting by the
term, both in
vertex
vertex.
in twin pregnancy. Both foetuses 2 viable infants were delivered at
presentation.
be faster than the maternal rate, and the foetal QRS is directed. Fig. 2 shows the foetal electrocardiogram in a twin pregnancy, both fcetuses presenting by the vertex. The rapid development of this technique suggests its early use seen to
oppositely
for such diagnosis. Breech presentations give 1. 2. 3.
a
reversed
E.C.G.
In
a
comparable
Larks, S. D., Dasgupta, K. Amer. Heart J. 1958, 56, 701. Larks, S. D. Amer. J. Obstet. Gynec. (in the press). Larks, S. D. in Medical Physics; vol. 3 (edited by O. Glasser). Chicago, Ill., 1959
Reticence or even repulsion from applying one’s mouth that of an apnoeic, but otherwise relatively well, patient should never be a consideration when a human life is involved. to
Department of Anæsthesia, Anaesthesia, University of Saskatchewan, Saskatoon, Canada.
B DOBKIN. ALLEN B. DOBKIN
THE FŒTAL ELECTROCARDIOGRAM AS A MEANS OF MINIMISING IRRIDIATION OF THE FŒTUS IN UTERO SIR In view of recent appreciation of radiation hazards, the tendency is to decrease irradiation of the foetus
possible. X-ray examination in suspected multiple pregnancy has been a fairly routine procedure, and a similar technique is used to gain informa-
in
utero to as
tion about the
little
as
position
of the foetus in difficult cases,
as
hospitals. Queen Mary’s is, in fact, now in a new " heyday " as a general children’s hospital, and if Sir Harry Platt would pay us the honour of a visit, as I hope he will, I think he would agree that the interests of the children in this area would best be served, and his committee’s recommendations most fully implemented, if the children’s hospital services of this area were concentrated upon Queen Mary’s. Queen Mary’s Hospital for Children, Carshalton, Surrey.
Fig. 1—Fœtal electrocardiogram in 3 normal vertex presentations. The fcetal complexes are directed up and the maternal complexes are
DAVID LAWSON.
NEW-TYPE OXYGEN CYLINDERS: A WARNING
SIR,—Iwas amazed at a remark in Dr. H. M. Bird’s letter of Jan. 31, 1959: " Fortunately the patient was not on controlled respiration, or he might well have died." It seems to me that every qualified physician, and particularly one who administers anxsthetics, should be able to apply effective artificial respiration to an apnoeic patient without the aid of a gas machine whenever the need arises!
directed down. The fcetal heart-rate is faster than the mater.
nal.
well as for other reasons, including diagnosis of foetal life. The foetal electrocardiogram with recently improved technique may prove to be an adequate alternative method, especially for diagnosis of multiple pregnancy, and particularly because it presents no radiation hazard. Methods and instrumentation have been described.1-3
Fig. 1 shows 3 examples of normal foetal electrocardiograms, with the foetus in vertex presentation. The foetal heart-rate is
"
For Breath Too is Nutrient " (Meneely 1) should never be the apnoeic victim has been dragged from the water, struck down in the street, partially buried in a cavein, or rendered apnoeic by the administration of curare. Of all the physicians who should be able to support the life of an apnoeic patient, the anxsthetist should be the last to be dependent entirely on a gas machine in order to prevent a patient from dying because controlled respiration is used and the machine suddenly becomes useless for administration of oxygen. Blowing air intermittently through an oral airway, or directly into the mouth of the victim while pinching the nose and supporting the mandible, should always be performed promptly until efficient mechanical devices can be applied, or until the victim has restarted spontaneous adequate breathing. If mouth-to-airway or mouth-to-mouth artificial respiration is kept in mind always, no anaesthetised patient’s life would ever be jeopardised just because an oxygen tank became empty and a proper replacement was not available, or did not fit the machine.
forgotten, whether
1.
Meneely, G.
R. Amer.
J. Med. 1955, 19, 323
Fig. 2—Fœtal electrocardiogram are
presenting by the
term, both in
vertex
vertex.
in twin pregnancy. Both foetuses 2 viable infants were delivered at
presentation.
be faster than the maternal rate, and the foetal QRS is directed. Fig. 2 shows the foetal electrocardiogram in a twin pregnancy, both fcetuses presenting by the vertex. The rapid development of this technique suggests its early use seen to
oppositely
for such diagnosis. Breech presentations give 1. 2. 3.
a
reversed
E.C.G.
In
a
comparable
Larks, S. D., Dasgupta, K. Amer. Heart J. 1958, 56, 701. Larks, S. D. Amer. J. Obstet. Gynec. (in the press). Larks, S. D. in Medical Physics; vol. 3 (edited by O. Glasser). Chicago, Ill., 1959